Cutaneous Lesions From Monkeypox Infection.

Abstract

A 33-year-old man presented to a sexually transmitted disease clinic in Lisbon with a 1-week history of facial and gluteal skin lesions. He had a mild fever and malaise during the first 3 days. He was otherwise healthy, reported sexual intercourse exclusively with men, and had no previous illnesses of sexual transmission. Physical examination disclosed multiple papules with a central dark crust distributed in the inner aspect of the buttocks, as well as an erosion on the posterior portion of the right thigh (Fig. 1). Two similar papules were found on the perioral region and a painful anterior cervical lymphadenopathy was palpable.Figure 1: Multiple papules with a dark crust in the center. Note the erosion on the right posterior thigh, compatible with a more advanced lesion. Figure 1 can be viewed online in color at www.stdjournal.com.A swab performed at the base of the lesions was sent to the Portuguese National Health Institute, which revealed the presence of monkeypox virus, via real-time polymerase chain reaction (PCR) technique. Serologies were negative for HIV, hepatitis C and syphilis. The PCR tests were positive for Chlamydia trachomatis in the urine, and Neisseria gonorrhoeae was positive in anal and oral samples. The PCR for herpes simplex virus 1 and 2 was not detected in the lesions. Antibiotic treatment for concomitant sexually transmitted diseases was prescribed. Regarding monkeypox infection, a symptomatic treatment was given, and contact isolation was advised. The patient made a full recovery in 1 week. Monkeypox is a rare zoonosis that is causing a worldwide outbreak.1 Cutaneous lesions frequently evolve the anogenital area and are variable during time, evolving from whitish papules, which become umbilicated with central crust and detach spontaneously in 1 to 2 weeks.2 When all the crusts fall off, the patient is no longer considered contagious. With this case, we intend to disclose a clinical picture, from this outbreak, and alert our colleagues worldwide for the different appearance of monkeypox lesions over time.